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.APPLICATION FO.. <br />CAFE""°"'° <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />� PLUMBING <br />0 <br />❑ SIGN <br />Gw EN <br />MAIL AORNCJs <br />/CY1l'4k- V-7 <br />�r«Fvuc <br />96^— <br />•_ <br />� �9/E� <br />ARCHITECT OR OESIGNER <br />MAIL ADDRESS <br />CRY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />n`Ilu�nwncpNTn.cr� <br />iADDRESS <br />fI <br />CITY P"Or <br />LICENSE <br />/ <br />i�1 <br />�7 <br />SS OF WORK <br />IYI_ NEW ❑ ADDITION ❑ <br />ALTERATION ❑ REPAIR ❑ <br />DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ <br />BUILDING RELOCATION <br />ALUATIONOF WORK(COST OF MAIEPIALS PLUS LABORI <br />I <br />DESCRIBE WORK <br />') z C/ h 7 <br />usE OF ewLDINB <br />/�-S/7�c%L <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETF-D WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DCSCRIPTION OF PROPERTY 15HOWN BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK OF <br />PROJECT ADDRESS <br />E If p <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL _ <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />ATER CLOSET ITOILETI <br />AIR COND. UNITS—H.P. EA. <br />ATHTUB <br />REFRIGERATION UNITS—H.P. EA.AVATORY(WASH <br />BASIN) <br />BOILERS—H.P. EA.HOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />f <br />ITCHEN SINKB DISP. <br />FORCED AIR SYSTEMS—B.T.U. MEA.ISHWASHER <br />WALL HEATERS—B.T.U. MAUNDRYTRAYUNIT <br />HEATERS—B.T.U. M <br />LOTHES WASHER <br />_ <br />_ <br />EVAPORATIVE COOLERSATER <br />HEATER <br />CLOTHES DRYERS _ <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— G.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEAOERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK ISERVICE—BAR, ETC.I <br />WOODSTOVE/FIPEPLACE INSERT <br />SUB TOTAL <br />SUB TIOTAL S <br />PERMIT A <br />PERMIT A <br />TOTAL FEE $1 <br />TOTAL FEE _ — A <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONt SETBACK <br />REAR 5EIBACK <br />SIDE SETBACK <br />PLAN CHECKINUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AIR <br />VACANT SITE <br />OVER ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITE <br />BUILDING <br />S <br />SIZE OF BLDG <br />NU OF STORIES <br />MAK OCC LOAD <br />PLUMBING <br />? <br />J <br />�V\ <br />1 <br />FIRE SPRINKLERS REQUIRED O YES O NO <br />1 MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ADD BY <br />nLANSCNECKEDBY <br />PPR FOR ISSUANCE BY A <br />TOTAL <br />// <br />ell-1 <br />